Recently, I had two female patients report having chronic UTIs. In the first instance, it was a twenty-eight-year-old woman who had an eighteen-month history of UTIs. What was most notable in her DNA sequencing of the urine from MicroGen Dx was the number of anaerobes seen. Coincidentally, the patient had started on semaglutide just before the start of her history of chronic UTIs. Once the semaglutide was stopped, the chronic UTI issue resolved.
In the second case, it was an older female patient in her late seventies that did have a history of chronic UTIs that were successfully treated, and she was being managed with fosfomycin once a week. In her case, she presented with an acute UTI after several months of being asymptomatic. The patient is also a diabetic and has been put on semaglutide by her endocrinologist. Stopping the semaglutide has improved the management of her chronic UTIs, and now she is symptom-free on once-a-week fosfomycin.
In both instances, the patients complained of developing constipation, which is a common side effect of semaglutide. Constipation has been associated with causing UTIs. Constipation puts increased pressure on the bladder, which can lead to incomplete emptying. In addition, constipation can also lead to inflammation of the colon and contribute to recurrent or chronic UTIs. There is also undue pressure on the pelvic floor, which can lead to pain with urination and contribute to inadequate emptying of the bladder.
Regardless, constipation can contribute to UTIs, and it is well known that both GLP-1 and GLP-1/GIPs, such as tirzepatide, cause decreased GI motility as one of the ways they assist in weight reduction. Another effect of decreased GI motility is reflux, or GERD. Many patients on these medications complain of GERD.
Medications such as GLP-1 or GLP-1/GIP are polypeptides that have several benefits, not only with weight reduction but can also assist in helping with fatty liver disease, reducing visceral adiposity (fat surrounding internal organs), and offering cardioprotection by helping reduce high cholesterol. There are, however, side effects that need to be addressed if observed, such as constipation and GERD. Another side effect often seen is fatigue.
The use of these polypeptides is not without controversy; many believe that diet and exercise should be enough. Unfortunately, for many, especially those with sedentary jobs, families, and horrendous commute times, there just aren’t enough hours in the day to carve out.
Preparing and cooking healthy meals and dedicating thirty minutes of exercise five to six days a week.
If you decide to try polypeptide therapy to assist in weight reduction or if it is suggested to try one to help with diabetes, high cholesterol, fatty liver disease, or visceral adiposity, be mindful of the side effects and address them. The simplest way is to add more fiber to your diet and drink enough water daily. The rule of thumb is half your body weight, and that is how many fluid ounces of water you should drink on a daily basis. So if you weigh two hundred pounds, then you should drink one hundred ounces of water a day minimally. Some also add an extra ounce of water for every ounce of caffeine products they drink daily.
The obesity epidemic in the United States is real, and it is becoming worldwide as we continue to hurt the rest of the world. GLP-1 and GLP-1/GIP polypeptide therapy can be an effective adjunct in addressing the obesity epidemic; just be mindful of the side effects.
